other
Posted May 20RxTriage Liaison (Infusion)
Durham, United StatesHybrid
Responsibilities
- Receive and review all incoming specialty and HCPA medication orders/referrals.
- Identify whether medication is billable under medical or pharmacy benefits and route accordingly.
- Conduct preliminary benefits review to identify: Coverage
- Identify missing elements and request documentation from providers as needed for appropriate routing.
- Ensure readiness before finalizing referral destination.
- Ensure referrals move seamlessly into the correct workflow for
- Maintain compliance with payer rules, infusion therapy standards, and site of care policies.
- Support audits or quality reviews by ensuring documentation is complete and consistent. Patient Interaction
- Collaborate with formulary or reimbursement specialists to identify preferred alternatives when necessary.
- Support process improvement efforts to streamline triage and referral routing.
Requirements
- experience when discussing site-of-care expectations or next steps. Additional Responsibilities
- Skills: Strong interpersonal communication skills, ability to work independently and demonstrate good judgement, strong verbal and written communication, highly proficient in Microsoft Office particularly Excel and Word; able to quickly learn other software programs and able to extract relevant information; strong organizational/administrative skills a must.
- High school diploma or GED required
- Current certification and/or licensure as a Pharmacy Technician in the state where the site is located is required (North Carolina).
- Should additional licensure need to be obtained, the applicant will commit to obtaining the required licensure within a mutually agreed upon timeframe.
- PTCB or NHA certification preferred. If the candidate does not have the PTCB or NHA at time of hire, they must commit to obtaining it within 9 months of employment.
- experience as a pharmacy technician required 3+ years’
- experience with infusions, coordinating and subcontracting referrals, infusion and medical reimbursement required;
- experience must include medical pre-certification,
- Experience with infusion, specialty pharmacy, and/or home infusion workflows strongly preferred
- Understands the pre-certification process for specialty/non-specialty infusions; knowledge and understanding of nuances of infusion therapy v. “standard” outpatient specialty pharmacy •
- Experience with major and local medical plans preferred; strong knowledge of Medicare and Medicaid regulations and commercial insurer criteria for payment of infusion and home care services
- Understanding of medical vs. pharmacy benefit distinctions, site‑of‑care policies, white‑bagging/brown‑bagging requirements, and authorization processes
- Familiarity with J‑codes, HCPCS codes (including per diem and nursing), and common infused medications highly beneficial
- Highly proficient in systems such as MS Office (e.g., Word, Excel), EMR systems (e.g., EPIC, Cerner), and dispensing systems (e.g. CPR+, EPIC WAM)
Benefits
- This role also ensures patients are routed efficiently based on insurance requirements, patient preference, clinical needs, reimbursement feasibility, and operational capacity.
- As needed, contact patients to clarify insurance, care preferences, or logistical considerations impacting routing.
- Knowledge of insurance plans, authorization processes, and medical terminology; strong problem-solving and critical-thinking skills.
- 5+ years health care experience required; 3+
- Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Additional details
- This role is onsite in Durham, NC for the first 6-8 weeks of training. Once the new hire is fully stabilized, they will be able to work hybrid 2-3 days a week onsite. Job Purpose:
- The company is seeking a highly motivated, detail-oriented, and dependable Triage Liaison to support our rapidly growing healthcare provider administered (HCPA) medication operations.
- This role is responsible for receiving, assessing, and directing incoming prescriptions and HCPA referrals to the appropriate site of care – Hospital Outpatient Departments (HOPD), Ambulatory Infusion Centers (AIC), Home Infusion (HI), or external/contract pharmacies/agencies.
- The RxTriage Liaison acts as the first decision point in the referral workflow process and collaborates with pharmacy, nursing, intake, revenue cycle management, and clinical partners to ensure timely access to care. The RxTriage Liaison will support a specific specialty clinic/s or be part of a centralized intake team serving multiple clinics and disease states/diagnosis requiring infusion therapy. Key Responsibilities
- Evaluate referral type, diagnosis, therapy, urgency, payer requirements, patient preference/home-care eligibility and clinicals documentation to determine the correct pathway (HOPD, AIC, HI, external entities).
- Verify patient demographics, prescriber information, therapy details, and completeness of required documentation
- Benefit & Eligibility Screening (Initial-Level Triage)
- requirements (site-of-care mandates, white-bagging, brown-bagging, or specialty pharmacy restrictions).
- Whether therapy is eligible for in-house care vs. must be dispensed externally.
- Potential red flags requiring escalation (e.g., no coverage, non-formulary status, narrow network).